Nurse-Led Disease Management Cost Effective

Hospital costs, but not total cost, decrease in a nurse-led disease management program

By Pat F. Bass, M.D.

HealthDay Reporter

WEDNESDAY, Oct. 22 (HealthDay News) -- A nurse-led disease management program is reasonably cost effective for patients with congestive heart failure, but the broader policy question of whether the health benefits are worth the costs is yet to be answered, researchers report in the Oct. 21 issue of the Annals of Internal Medicine.

Paul L. Hebert, Ph.D., of the Veterans Affairs Puget Sound Health Care System in Seattle, and colleagues performed a randomized, controlled effectiveness trial evaluating a nurse-led disease management program for congestive heart failure patients. Patients were randomly assigned to either usual care (203 patients) or a nurse-led program (203 patients) consisting of one in-person visit with periodic telephone follow-up over 12 months. Main outcome measures were cost-effectiveness as measured by the incremental cost-effectiveness ratio (ICER) and self-reported quality of life (Health Utilities Index Mark 3 and EuroQol-5D).

Both costs and quality of life were greater in the nurse-managed group compared to the usual care group with ICERs costing $17,543 per EuroQol-5D based quality-adjusted life-year (QALY) and $15,169 per Health Utilities Index Mark 3-based QALY (in 2001 dollars), the researchers found. From a payer perspective such as Medicare, the ICER ranged from $3,673 to $4,495 per QALY. Calculating a societal ICER by replacing local costs with national cost estimates places QALY costs from $13,460 to $15,556. Cost-effectiveness acceptability curves indicate New York Heart Association class I and II patients would gain the most benefit, the authors report.

"At less than $25,000 per QALY saved, this nurse-led disease management program was reasonably cost-effective over 12 months, especially for patients with earlier stages of heart failure," Hebert and colleagues conclude. "The intervention costs of $2,177 per patient were more than offset by reduced hospital costs ($2,378 per patient), but higher costs for outpatient procedures, medications, and home health care prevented the intervention from being cost-saving over the 12-month study."